Texas Therapy Reimbursement Rates by Payer: Aetna vs Blue Cross vs UnitedHealthcare (2026)

In Texas, which payer pays you the most depends on your license. Aetna’s HMO lists the highest therapy rates for counselors and social workers, UnitedHealthcare’s Optum network pays psychologists the most, and Blue Cross Blue Shield of Texas leads for psychiatric nurse practitioners.

Each payer’s data covers a different slice of its business. The Aetna figures cover only Aetna’s Texas HMO employer plans. The Blue Cross figures cover all seven of its own Texas networks, PPO and HMO. The UnitedHealthcare figures come from Optum’s behavioral health network, which serves UnitedHealthcare plans. Read each number as that payer’s slice, not its whole book.

How Did We Compare Texas Payers’ Therapy Rates?

We read each payer’s own rate files and kept clinicians whose registered practice address is in Texas.

• Aetna. Both files from Aetna Health Inc., the company the Texas Department of Insurance licenses as Aetna’s HMO, for September 2026.
• Blue Cross Blue Shield of Texas. Its seven network files for August 2026, covering Blue Choice PPO, Blue Essentials, Blue Advantage HMO, Blue Premier, MyBlue Health HMO and ParPlan.
• UnitedHealthcare. The September 2026 behavioral health file from Optum, UnitedHealthcare’s sister company. It covers Optum’s whole national network, and UnitedHealthcare of Texas publishes a copy of it.

We matched every provider ID number against the federal NPPES registry and kept individual behavioral health clinicians. We kept negotiated rates billed as professional claims, plus Aetna’s fee schedule rates. We dropped percentage, per diem and $0.00 placeholder rows, and Aetna’s reduced and discontinued testing rates. The table counts each distinct clinician and rate pair once.

Most clinicians hold rates from more than one of these payers. For them, we also compared each person’s rates directly, using the middle rate when a clinician has several at one payer.

Texas Therapy Reimbursement Rates by Payer (2026 Table)

Each row comes from that payer’s machine readable files for the month shown, filtered to individual behavioral health clinicians with a Texas practice address.

Aetna’s medians lead on 90837 and 90791 because counselors and social workers make up most of every network. Aetna’s 90837 median is $130.22, about $12 above Blue Cross at $117.91 and about $20 above UnitedHealthcare at $110.30. For testing, UnitedHealthcare leads at $120.30, but it lists a 96130 rate for far fewer clinicians than the other two.

Which Payer Pays Texas Counselors and Social Workers the Most for 90837?

Aetna’s HMO lists the highest rates. For counselors, clinical social workers and marriage and family therapists, the 90837 medians across each network are:

• Aetna. $130.22.
• UnitedHealthcare. $110.30.
• Blue Cross Blue Shield of Texas. $109.54.

Comparing the same clinicians gives the same result. Of 14,945 counselors with a 90837 rate from both Aetna and Blue Cross, Aetna’s middle rate is higher for 98 percent, by about $23. Against UnitedHealthcare, it is higher for 84 percent, by about $17.

The catch is how many rates Aetna lists. A typical Texas therapist has six Aetna 90837 rates, the lowest usually $93.28, and the file does not say which one pays. Aetna’s lowest listed rate beats Blue Cross for only 40 percent of those counselors. If Aetna pays you its low rate, Blue Cross may pay you more. Our Aetna Texas behavioral health rates page explains the pattern behind those listings.

Blue Cross’s amount depends on the network. Its Blue Choice PPO pays therapists $112.29, Blue Essentials $109.54, and Blue Advantage HMO, MyBlue Health, Blue Premier and ParPlan $104.75. Our Blue Cross Blue Shield of Texas behavioral health rates page has its full table.

Which Payer Pays Texas Psychologists the Most?

UnitedHealthcare does. Its 90837 median for Texas psychologists is $147.07, against $131.63 at Blue Cross and $127.51 at Aetna.

Of the 804 psychologists with a 90837 rate from all three payers, UnitedHealthcare pays the most for 683, about 85 percent. The pattern holds for the intake. UnitedHealthcare’s 90791 median for psychologists is $174.86, against $153.00 at Aetna and $146.04 at Blue Cross.

The reason is how each payer treats license. Optum pays Texas psychologists about a third more than therapists for 90837. Blue Cross pays them about a fifth more. Aetna pays psychologists slightly less than therapists at the median, so a psychologist gains the least from an Aetna contract.

Which Payer Pays Psychiatric Nurse Practitioners and Psychiatrists the Most in Texas?

Blue Cross Blue Shield of Texas, for most psychiatric nurse practitioners. Of the 901 listed by all three payers, Blue Cross pays the highest 90837 rate for 554, about three in five.

• Psychiatric nurse practitioners. 90837 medians of $137.94 at Blue Cross, $129.21 at Aetna and $125.01 at UnitedHealthcare.
• Psychiatrists. $165.28 at Blue Cross, $147.07 at UnitedHealthcare and $138.41 at Aetna. Among the 890 listed by all three, Blue Cross pays the most for 417, under half.

Blue Cross’s network matters even more here. Its Blue Choice PPO pays psychiatrists a median of $192.05 for 90837, against $144.14 on Blue Advantage HMO. Most psychiatrists bill medication visits with other codes, so treat their therapy rates as a secondary comparison.

Which Payer Pays More for Psychological Testing (96130) in Texas?

UnitedHealthcare, for most clinicians it lists. Of the 3,572 clinicians with a 96130 rate from all three payers, UnitedHealthcare pays the most for 2,771, about four in five.

For psychologists, the network medians for the first testing hour are $120.30 at UnitedHealthcare, $108.55 at Aetna and $104.54 at Blue Cross. Among psychologists listed by both, UnitedHealthcare pays more than Blue Cross for 96 percent and more than Aetna for 91 percent.

UnitedHealthcare also lists far fewer testing rates. It attaches a 96130 rate to 4,657 Texas clinicians, against 29,894 at Aetna and 40,398 at Blue Cross. Before you add testing hours for a UnitedHealthcare patient, check that your Optum agreement lists 96130 at all.

Can You Get Your Fee Schedule From a Texas HMO or PPO?

Yes, if you contract directly with a Texas-regulated HMO or PPO insurer. The contract must let you request your fee schedule, and the HMO or insurer must send it within 30 days.

Insurance Code section 843.321 sets the rule for HMOs like Aetna Health Inc. Section 1301.136 sets the same rule for PPO insurers, and the chapter extends it to EPO plans. Licensed counselors, social workers, family therapists, psychologists and nurse practitioners all count as providers under these sections. Both sections give you four rights.

• The schedule itself. You can request the fee schedules and coding guidelines for the procedures you bill under the contract.
• A 30-day deadline. The plan or its agent must send them within 30 days of receiving your request.
• Notice before changes. Any change that would change your payment needs 90 days’ notice, and the plan cannot revise the schedule retroactively.
• A way out. You can end the contract within 30 days of receiving the information, without penalty or different treatment in the plan’s other products.

A contract cannot waive any of this. You may use the schedule for practice management and billing, or share it with a regulator. The request matters most for Aetna, where the published file lists several rates for most clinicians and only your schedule says which one is yours. Two kinds of contract may fall outside these sections. A self-funded employer plan that a payer only administers follows federal law. A contract signed with Optum, which runs UnitedHealthcare’s behavioral health network, may not count as a contract with the insurer, so ask Optum for the schedule directly.

What This Means for Your Practice

If you are growing a group practice, credential each new clinician with the payer that pays their license the most first. Each payer credentials clinicians separately, so the order you apply in decides which patients a new hire can see first and at what rate.

• New counselors, social workers and family therapists. Start with Aetna’s HMO, where the 90837 median is about $20 above the other two. Ask Aetna which of its listed rates the new clinician will be paid, because its lowest rate sits below Blue Cross. Blue Choice PPO at $112.29 and Optum at $110.30 are close seconds.
• New psychologists. Start with Optum, which pays Texas psychologists $147.07 for 90837 and the most for testing. Confirm the Optum agreement lists 96130 before you schedule testing. Blue Cross at $131.63 comes next.
• New psychiatric nurse practitioners. Start with Blue Cross. Its Blue Choice PPO pays them a median of $162.34 against $118.31 on Blue Advantage HMO, so check which Blue Cross networks the contract includes. Aetna at $129.21 comes next.

Once each contract is signed, request the fee schedule for the new clinician under section 843.321 or 1301.136. The same sections let you leave the contract without penalty within 30 days of receiving it. If the rate is well below the median for that license, that is your window to ask for more before patients are booked. Our guide to negotiating insurance contract rates covers how to ask. For the same comparison in California, see our California therapy rates by payer.

The contracted rate is only half of the picture. Fuse tracks what every payer actually pays on your claims, so you can see which payers pay what they agreed and which do not.

Disclaimer: This article uses rate information from the Machine Readable Files that Aetna, Blue Cross and Blue Shield of Texas and UnitedHealthcare publish under the federal Transparency in Coverage rule. These files are posted to satisfy the regulation, not to be read, and Fuse built its own software to extract and verify the figures above. This analysis covers three payers and will not reflect rates from every insurer in Texas. Healthcare pricing changes frequently, and individual contracts and circumstances affect actual payment. This information does not guarantee specific pricing. Practices should verify current rates directly with each payer before relying on them for billing or negotiation decisions.